Bisphenol A (BPA) is an endocrine disrupting chemical used to synthesize polycarbonate plastics and epoxy resins. Previous research suggests that exposure to it can alter children's behavior. The ...objective of this study is to conduct a systematic review of the existing literature, examining associations between prenatal and childhood BPA exposure and behavior in children up to 12 years of age. We searched electronic bibliographic databases (MEDLINE, PubMed, EMBASE, PsycINFO, CINAHL, and ERIC), reference lists of included articles, and conference abstracts (American Psychiatric Association, American Academy of Neurology, Pediatric Academic Societies, and International Society of Environmental Epidemiology). We included original studies reporting on the association between prenatal and childhood BPA exposure that measured BPA metabolites in urine and children's behavioral outcomes. From 2811 citations, 11 articles met our inclusion criteria. Descriptive analyses indicated that prenatal exposure to maternal BPA concentrations were related to higher levels of anxiety, depression, aggression, and hyperactivity in children. BPA exposure in childhood was associated with higher levels of anxiety, depression, hyperactivity, inattention, and conduct problems. Limited observational evidence suggests an association between both prenatal and childhood exposure to BPA and adverse behavioral outcomes in children. Prospective cohort studies are needed to clarify these associations.
Emerging evidence from observational studies suggests that prenatal exposure to phthalates affects neurodevelopment in children.
To conduct a systematic review of the existing literature on the ...association between urinary phthalate concentrations and children's neurodevelopment.
We searched electronic bibliographic databases (MEDLINE, PubMed, EMBASE, PsycINFO, CINAHL, Global Health, CAB abstracts, and ERIC) (1910 to February 21st, 2014); reference lists of included articles, and conference abstracts (American Psychiatric Association, American Academy of Neurology, and Pediatric Academic Societies). Two independent reviewers screened abstracts and extracted data. We included original studies reporting on the association between prenatal or childhood urinary phthalate metabolites, and cognitive and behavioral outcomes (e.g., IQ scores, BASC-2 scores or equivalent) in children 0–12 years of age.
Of 2804 abstracts screened, 11 original articles met our criteria for inclusion.
A systematic review of the literature supports the contention that prenatal exposure phthalates is associated with adverse cognitive and behavioral outcomes in children, including lower IQ, and problems with attention, hyperactivity, and poorer social communication. Further research characterizing the associations between specific phthalate metabolites and children's neurodevelopmental outcomes is needed to support the development of mitigation strategies and enhance the development of appropriate health policy.
•Prenatal maternal urinary concentrations of phthalate metabolites appear to be associated with adverse cognitive and behavioral outcomes in children.•Both low molecular weight (e.g., monobutyl phthalate, MBP) and high molecular weight (e.g., di(2-ethylhexyl) phthalate, DEHP) phthalate metabolites are associated with adverse cognitive and behavioral outcomes.•Sex-specific effects from phthalate exposure were noted between low (e.g., mono-n-butyl phthalate, MnBP) and high (e.g., DEHP) molecular weight phthalate metabolites, and cognitive and behavioral outcomes.
Animal models show that prenatal bisphenol A (BPA) exposure leads to sexually dimorphic disruption of the neuroendocrine system in offspring, including the hypothalamic-pituitary-adrenal (HPA) ...neuroendocrine system, but human data are lacking. In humans, prenatal BPA exposure is associated with sex-specific behavioural problems in children, and HPA axis dysregulation may be a biological mechanism. The objective of the current study was to examine sex differences in associations between prenatal maternal urinary BPA concentration and HPA axis function in 3 month old infants.
Mother-infant pairs (n = 132) were part of the Alberta Pregnancy Outcomes and Nutrition study, a longitudinal birth cohort recruited (2010-2012) during pregnancy. Maternal spot urine samples collected during the 2nd trimester were analyzed for total BPA and creatinine. Infant saliva samples collected prior to and after a blood draw were analyzed for cortisol. Linear growth curve models were used to characterize changes in infant cortisol as a function of prenatal BPA exposure.
Higher maternal BPA was associated with increases in baseline cortisol among females (β = 0.13 log μg/dL; 95% CI: 0.01, 0.26), but decreases among males (β = -0.22 log μg/dL; 95% CI: -0.39, -0.05). In contrast, higher BPA was associated with increased reactivity in males (β = .30 log μg/dL; 95% CI: 0.04, 0.56) but decreased reactivity in females (β = -0.15 log μg/dL; 95% CI: -0.35, 0.05). Models adjusting for creatinine yielded similar results.
Prenatal BPA exposure is associated with sex-specific changes in infant HPA axis function. The biological plausibility of these findings is supported by their consistency with evidence in rodent models. Furthermore, these data support the hypotheses that sexually dimorphic changes in children's behaviour following prenatal BPA exposure are mediated by sexually dimorphic changes in HPA axis function.
The compensation gap between male and female physicians in Canada is a well-documented issue. Male physicians consistently receive higher compensation than their female counterparts, even after ...accounting for factors such as hours worked and number of patients seen. This gap can be understood as three types of inequalities: within-specialty, between-specialty, and patient-specific compensation inequality. Within-specialty inequality refers to differences in payment for male and female physicians delivering the same services. Between-specialty inequality refers to differences in compensation between male-predominant and female-predominant specialties. Patient-specific inequality refers to differences in compensation for services provided to female compared to male patients. These inequalities are further exacerbated by the feeforservice model of physician compensation in Canada. A standardized and transparent approach to compensation with an equality lens is needed to address these structural inequalities. This approach should include analyzing and reporting variations in billing codes between provinces to identify outliers that may need further consideration. Compensation transparency and a standardized compensation process based on objective measures can help reduce sex-based inequality.
Abstract
Background: A discrepancy exists between clinician-led studies of people's experience of electroconvulsive therapy (ECT) and consumer-led studies, with the former typically being much more ...positive about the efficacy and side effects of ECT compared with the latter. Qualitative in-depth explorations of people's experiences of ECT are relatively rare, particularly those looking specifically at women's experience of ECT.
Aims: The aim of this qualitative study was to explore women's experiences of ECT, particularly their experience of knowledge and power related to ECT.
Results: Qualitative analysis of the interviews with nine women resulted in four main themes emerging from the interviews with the women: (i) "he really didn't say much," (ii) "I'm going to be very upset with you," (iii) "I was just desperate," and (iv) "it was like we were cattle."
Conclusions: Overall, participants found their experiences with ECT to be quite negative, and characterized by a lack of knowledge during the procedure, and a lack of power throughout the entire process.
To evaluate the clinical outcomes pre- and post-implementation of an evidence-informed surgical site infection prevention bundle (SSIPB) in gynecologic oncology patients within an Enhanced Recovery ...After Surgery (ERAS) care pathway.
Patients undergoing laparotomy for a gynecologic oncology surgery between January–June 2017 (pre-SSIPB) and between January 2018–December 2020 (post-SSIPB) were compared using t-tests and chi-square. Patient characteristics, surgical factors, and ERAS process measures and outcomes were abstracted from the ERAS® Interactive Audit System (EIAS). The primary outcomes were incidence of surgical site infections (SSI) during post-operative hospital admission and at 30-days post-surgery. Secondary outcomes included total postoperative infections, length of stay, and any surgical complications. Multivariate models were used to adjust for potential confounding factors.
Patient and surgical characteristics were similar in the pre- and post-implementation periods. Evaluation of implementation suggested that preoperative and intraoperative components of the intervention were most consistently used. Infectious complications within 30 days of surgery decreased from 42.1% to 24.4% after implementation of the SSIPB (p < 0.001), including reductions in wound infections (17.0% to 10.8%, p = 0.02), urinary tract infections (UTI) (12.7% to 4.5%, p < 0.001), and intra-abdominal abscesses (5.4% to 2.5%, p = 0.05). These reductions were associated with a decrease in median length of stay from 3 to 2 days (p = 0.001). In multivariate analysis, these SSI reductions remained statistically significant after adjustment for potential confounders.
Implementation of SSIPB was associated with a reduction in SSIs and infectious complications, as well as a shorter length of stay in gynecologic oncology patients.
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•A Surgical Site Infection Prevention Bundle (SSIBP) requires coordination between healthcare providers.•Evaluating the implementation of a SSIBP in gynecologic oncology patients is challenging.•SSIPB Implementation is associated with improved surgical outcomes: shorter length of stay and fewer infections.
Objective: The objective of this work was to estimate the association between surgeon sex with surgical postponements or cancellations. Summary Background Data: Female surgeons receive lower hourly, ...per patient, and total compensation than their male colleagues. Bias in the decision to postpone or cancel surgical cases may contribute to compensation inequality, since this results in unpaid surgeon time. Methods: This retrospective cohort study used administrative health data to identify surgeries performed at four hospitals in Calgary, Alberta, Canada that were cancelled or postponed due to surgeon/operating room overbooking or to accommodate an emergency case between April 1, 2015, and March 31, 2020. Surgeries performed in dedicated operating or procedure rooms (e.g., bronchoscopy, cardiac surgery, etc.) were excluded. The exposure of interest was surgeon sex, identified by matching their name to the provincial regulatory body record of self-identified sex, which allowed for selection between female and male only during the time of this study. Results: There were 214,832 eligible surgical cases, of which 1,481 and 2,473 were postponed or cancelled due to overbooking and to accommodate an emergency, respectively. After adjusting for surgical specialty, whether the procedure was a day case, and for patient sex, female surgeons were more likely to be cancelled or postponed to accommodate an emergency case compared to male surgeons (odds ratio OR 1.21, 95% confidence interval CI 1.05-1.38). Conclusion: There may be sex-bias in the decision about which surgical cases to postpone or cancel to accommodate emergency surgeries in our setting. This bias may contribute to compensation inequality in a fee-for-service setting.
To understand trainee experiences of participating in a living systematic review (LSR) for rheumatoid arthritis and the potential benefits in terms of experiential evidence-based medicine (EBM) ...education.
We conducted a mixed-methods study with trainees who participated in the LSR and who were recruited broadly from training programs in two countries. Trainees received task-specific training and completed one or more tasks in the review: assessing article eligibility, data extraction, and quality assessment. Trainees completed a survey followed by a one-on-one interview. Data were triangulated to produce broad themes.
Twenty one trainees, most of whom had a little prior experience with systematic reviews, reported a positive overall experience. Key benefits included learning opportunities, task segmentation (ability to focus on a single task, as opposed to an entire review), working in a supportive environment, international collaboration, and incentives such as authorship or acknowledgment. Trainees reported improvement in their competency as a Scholar, Collaborator, Leader, and Medical Expert. Challenges included communication and technical difficulties and appropriate matching of tasks to trainee skillsets.
Participating in an LSR provided benefits to a wide range of trainees and may provide an opportunity for experiential EBM training, while helping LSR sustainability.
•Trainees from a wide range of backgrounds reported very positive overall experiences from participating in a living systematic review (LSR).•LSRs may provide an ongoing opportunity for experiential learning in evidence-based medicine education.•Engaging trainees in LSRs may help ensure review sustainability, while providing valuable learning opportunities that can be tailored to trainees' skills and interests.
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